Dear Doctor: It seems like gut microbes are part of every kind of health issue now. I just read that having the wrong bacteria causes pulmonary hypertension, which is something our dad had before he died. Is that really true? How can it be fixed?

Dear Reader: We’re right there with you in being amazed by the breadth and depth of the role of the gut microbiome in health and well-being. The emerging research these days is fascinating, and it continues to shape and expand our understanding of how the body functions. In your question, you’re referring to the results of research published last February in the American Heart Association’s journal Hypertension. According to the study, researchers found that a specific assortment of gut bacteria may not only contribute to a certain type of pulmonary hypertension, but also may be useful in predicting its onset.

Let’s start by talking about the condition itself. When someone has pulmonary hypertension, it means that something has caused high blood pressure in the arteries of their lungs. This is in contrast to general hypertension, which is high blood pressure in the arteries throughout the body. The study that you’re asking about focuses on a specific subset of the disease, known as pulmonary arterial hypertension, or PAH. That’s when progressive scarring damages the walls of the small arteries within the lungs, which makes them stiff and narrow and slows down blood flow. As blood pressure rises, the right side of the heart has to work harder. Over time, this extra workload taxes the heart and causes it to become enlarged and weakened, which leads to a new set of problems.

Symptoms of PAH include fatigue, shortness of breath, heart arrhythmias, and swelling in the feet, legs, abdomen and neck. Although the condition can arise on its own, it has been associated with congenital heart disease, COPD, chronic liver disease and drug use.

PAH is a serious and progressive disease, and there is no known cure at this time. Because the symptoms are common to many conditions, it can be hard to diagnose in its earliest stages. When PAH is suspected, diagnosis begins with blood tests, chest X-rays, scans of the heart and lungs, and endurance tests. The condition is confirmed with a procedure known as right heart catheterization, which allows a direct measurement of blood pressure within the main pulmonary arteries. Treatment focuses on managing symptoms with blood thinners, diuretics and supplemental oxygen.

The new PAH findings hint at a radical new approach to the disease. In the study, researchers analyzed stool samples from 18 PAH patients and 12 people with no history of cardiopulmonary disease. They were surprised to find the PAH patients’ microbiomes harbored a specific collection of bacteria that were absent in the stool of the healthy test subjects. According to the study results, the presence of those specific bacteria predicted a diagnosis of PAH with 83% accuracy. It’s a small study, and many questions remain. But if the results are corroborated in future research, this new direction holds promise for new avenues in PAH diagnosis and therapy.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Hello, dear readers, and welcome to this month’s letters column. In the midst of so much turmoil and uncertainty, we’re more grateful than ever for this chance to communicate with you.

-- Several of you wrote about the frustration of seeing someone exit a public restroom without washing his or her hands. “I find this upsetting at the best of times, but during the COVID-19 outbreak, I am more concerned than offended. What can be done?” a reader asked. Unfortunately, you can’t force people to practice good hygiene. However, you can take steps to protect yourself from the effects of their bad habits. Push swinging doors open with a shoulder, elbow or knee. Use toilet paper or a paper towel to protect yourself from any surfaces that you have to touch, such as the lock on the stall door, faucets on the sink and the door handle on the way out. Don’t rest personal items, such as a purse, on a public bathroom countertop. Be sure to dispose of the used barrier paper safely in a trash can. And, of course, wash your hands.

-- On the topic of hand-washing, we received a lot of mail asking about the effectiveness of hand sanitizers. The short answer is that 20 seconds of thorough hand-washing with soap and water is the preferred method of protecting against all types of germs and microbes. However, when this isn’t possible, an alcohol-based hand sanitizer of at least 60% concentration is a good alternative. The problems arise when people fail to use a large enough volume of hand sanitizer, or when they wipe the product off of their hands before it has completely dried. The takeaway here is to use the proper-strength products and read and follow the directions.

-- In that same vein, some of you told us you are confused that hand sanitizers, which are marketed as antibacterial, are being recommended for use during a virus outbreak. The answer is that hand sanitizers do not target a specific microbe; they work by damaging the exterior membranes of a wide range of organisms. This includes bacteria and some viruses. Although not all viruses have an exterior membrane, the coronavirus does, so hand sanitizers are useful at this time. However, as we noted, the proper alcohol concentration is crucial to the work of destroying the membrane, so use the right product and follow the instructions.

Thank you to everyone who has written with kind words. Knowing that these columns are useful means a lot to us. (And to Glenda in Tulsa, who just turned 83, your note about who you want to be “when I grow up” made us laugh out loud.) We appreciate the time and care you all put into your letters and emails, and we will revisit some topics with your thoughtful suggestions in mind. We look forward to our next batch of mail and to seeing you here again next month. Please take care of yourselves -- and stay safe.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: My husband frequently has hiccups, and sometimes they last for days. What causes them? Is there any way to make them stop?

Dear Reader: Hiccups are due to a sudden and involuntary contraction of the diaphragm. That’s the dome-shaped structure that separates the thoracic cavity, also known as the chest cavity, from the abdominal cavity. The diaphragm, which is made up of muscle and membranes, serves both as the floor of the thoracic cavity and the roof of the abdominal cavity. Its motion is responsible for your ability to inhale and exhale. The diaphragm also plays a propulsive role in sneezing, coughing, crying, vomiting and eliminating feces and urine.

When you’re breathing normally, the diaphragm contracts and flattens out, moving downward in a smooth motion as you inhale. The lungs expand into the added space, which allows air to enter. The exhale occurs when the diaphragm returns to its natural domed shape, which crowds the supple lung tissues and forces the air out. When something causes the diaphragm to flatten suddenly in a convulsive motion, the resulting inward rush of air causes the structures at the top of the windpipe, including the vocal cords, to snap shut. This makes the distinctive “hic” sounds that gives the hiccups their name.

You can get the hiccups for no apparent reason. They are also associated with common triggers such as eating too much or too quickly; foods that are hot or spicy; fizzy beverages; alcohol; smoking; and emotional extremes, like stress, fear, or getting excited and laughing. In most cases, hiccups will clear up on their own, as quickly and mysteriously as they appeared.

When they last for more than a few days, or even a few weeks, they are known as persistent hiccups. When the condition lasts for more than a month, which is rare, they are referred to as intractable, or chronic, hiccups. For reasons that are not fully understood, these are more common in men than in women. Charles Osborne, a farmer in Iowa, had the hiccups for 68 years, a fact that earned him a spot in the Guinness Book of World Records.

Persistent hiccups are associated with irritation or damage to the phrenic or vagus nerves, which travel to the diaphragm. These can include growths in the neck, such as a cyst or tumor; gastroesophageal reflux disease, or GERD; or even just a sore throat. They have also been associated with serious conditions, such as kidney disease, diabetes, multiple sclerosis and stroke. For some people, general anesthesia during surgery can cause the onset of persistent hiccups.

Prolonged hiccups can interfere with eating, sleeping and quality of life. It would be a good idea for your husband to check with your family doctor for a diagnosis. Blood, imaging or endoscopic tests may be used to see if an underlying medical condition is causing the episodes. Treatment can include certain medications, including muscle relaxants, sedatives or anticonvulsants. Some patients report success with acupuncture or hypnosis. In the most severe cases, surgery can be an option, but potential complications can be severe.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)